Cerebral salt wasting syndrome

Abstract

Hyponatremia following acute or chronic central nervous system injury which is due to excessive Na+ loss in the urine without an increase in the body fluid, has been described as Cerebral Salt Wasting Syndrome (CSWS). This syndrome is often confused with dilutional hyponatremia secondary to inappropriate ADH secretion. Accurate diagnosis and management are mandatory for to improve the course of the disease. In this study a patient with CSW Syndrome is presented and the treatment and diagnosis of this syndrome are discussed in view of the literature.

Causes and Management of Hyponatremia

“…The appropriate treatment of patients with CSW is fluid and salt supplementation. 30,31 Hyponatremia is a common and potentially serious complication of sustained long-distance exercise, such as marathon running, due to sodium loss in sweat, excessive water intake, or both. 32, 33 A greater awareness of these po- tentially adverse biochemical changes that may result from prolonged strenuous exercise and instruction in the appropriate approach toward fluid intake may help to decrease the incidence of symptomatic hyponatremia associated with such periods of exercise.…”

“…32, 33 A greater awareness of these po- tentially adverse biochemical changes that may result from prolonged strenuous exercise and instruction in the appropriate approach toward fluid intake may help to decrease the incidence of symptomatic hyponatremia associated with such periods of exercise. 31…”

Suspected Cerebral Salt Wasting Syndrome with Cervical Spinal Lesion in a Domestic Shorthair Cat

“…In human medicine, CSWS can be included in the differential diagnosis of hyponatremia in patients with cerebral insults [ 14 ]. Uygun et al were the first to propose the following CSWS diagnostic criteria [ 15 ]: (1) central nervous system injury, (2) plasma [Na] 130 mmol/L, (3) urine [Na] > 80 mmol/day or >20 mmol/L, (4) osmotic pressure of plasma 270 mmol/L, (5) urine osmotic pressure/blood osmotic pressure >1, and (6) urine volume >1800 mL/day. In addition, Leonard et al proposed the main criteria to diagnose CSWS [ 16 ]: (1) brain pathology examination; (2) hyponatremia; (3) hypovolemia; and (4) urinary salt loss.…”

Akute symptomatische Hyponatriämie bei einem 70-jährigen Patienten

“…Dieses 1950 von Peters et al beschriebene Syndrom ist charakterisiert durch massiven renalen Salzverlust sowie Volumendepletion und kann durch tägliches Wiegen und Messen des zentralen Venendrucks von dem SIADH differenziert werden [11,16,19]. Die Unterscheidung zwischen SIADH und CSWS als mögliche Ursachen einer Hyponatriämie ist von zentraler Bedeutung, da eine Flüssigkeitsrestriktion, welche die Therapie der ersten Wahl bei SIADH darstellt, bei einem CSWS Komplikationen, vor allem einen zerebralen Infarkt, hervorrufen kann [32,35]. Die subarachnoidale Blutung ist häufig mit einer Hyponatriämie verbunden.…”

“…Das atriale natriuretische Peptid (ANP) wird für die massive Natriurese beim CSWS verantwortlich gemacht [32,35]. Auch in der Pädiatrie wurde das CSWS beschrieben.…”